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CCG leadership criticised

It’s not been an easy 2017 for Somerset Clinical Commissioning Group.

The county’s biggest CCG had previously managed to avoid the regulatory intervention its neighbours in Devon and North Somerset have experienced, but that changed last month.

Increasing patient demand and a 40 per cent rise in costs of nursing home fees meant the CCG ended 2016-17 with its first deficit (of £3m) and its financial gap for 2017-18 stands at around £15m.

The financial challenge facing the CCG is felt across the Somerset Sustainability and Transformation Partnership, as the area – which includes a primary and acute care systems vanguard in Yeovil – is one of those in the capped expenditure process.

A few weeks ago, the CCG was dealt another blow when it was rated inadequate by NHS England and put in special measures.

Once it became clear to the CCG that it wouldn’t meet its financial targets for 2016-17, it decided to commission a review into its own leadership.

The review, based on interviews with members of the CCG and external stakeholders, has not been published but HSJ obtained the executive summary.

It revealed, among other things, that the senior leadership has been spending too much time in meetings and its decision making ability is seen as “weak”.

Consultants Attain also warned that plans to improve financial performance were not being implemented fast enough.

Somerset CCG has accepted the review’s eight recommendations and work is under way to address the highlighted issues.

The departure of experienced leader David Slack at the end of August means new blood will be required to drive the organisation forward.

The shape of ACOs

Accountable care organisations can’t be simpy “willed” into existence through a transactional process, NHS England says, but a national contract sure does help them along.

Last week NHS England published its model contract for ACOs. Despite prior plans to have a separate contract for the development of multispecialty community providers, this new contract has superseded them and will be used for those looking to develop both hospital and primary care led models of care.

As often happens, the contract isn’t the finished article and will need some tweaking and national level changes to work. Some of those changes include amending the law, which will particularly please those going down the CCG and council integration route.

The new contract largely reflects the draft MCP contract, published in December, with the exception being slightly more detail and clarity around issues of payment and accountability.

One new detail might give GPs cause for concern. Prior to this contract, national plans were touted for a “voluntary” GP contract, which then morphed into the MCP contract in which GPs were told they could “suspend” their GMS or PMS deals if they wished to join an MCP.

The ACO contract includes this plan but with one proviso: GPs who suspend their contract and decide to go back after two years (if the ACO was failing, for example) would no longer be entitled to their registered patient list. Patients would remain with the ACO unless they chose otherwise – potentially leaving GPs patientless.

Expect this not to go down well with a lot of the GP population; if the “voluntary contract” was unpopular before, this detail won’t win any new fans.

However, this is hypothetical at the moment as the Department of Health will first have to agree legal changes to allow GPs a contract suspension.

Another law change NHS England claims will be carried out, possibly next year, will allow CCGs to pool all of their budgets.

A lot of questions remain unanswered in the 16 supporting documents, but what is clear is that NHS England does not expect lots of fully fledged ACOs to pop up over the country following this contract. It has maintained the line that most places will first be looking to develop accountable care systems, which do not require the tender of a big contract.